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These cases, however, were isolated and generally resulted from high ginseng doses or with the concomitant use of other substances (e.g., phenelzine, cannabis, herbal supplements); mania was not reported in clinical studies using ginseng alone or in combination. More interestingly, several cases of manic-like effects, such as confusion, agitation, irritation, nervousness, anxiety, and bizarre behavior, without history of psychiatric disorder, were reported following ginseng use [77,78,81,85,87,88,90,228]. In fact, most clinical studies with ginseng or ginsenosides reported no psychiatric or neurological side effects or statistically insignificant effects compared to placebo, and were not included in Table 1 [223,224,225,226,227]. Avoid products containing undisclosed or harmful ingredients, prioritize brands committed to product safety and efficacy, and consult a healthcare professional if you have any concerns. 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Foster Johnson, one of the Augmenta attorneys, also tracked down some of the patients who’d posted horror stories online. Augmenta’s team endeavored to put the safety record of the Penuma on trial, securing Elist’s confirmation in a deposition that 20% of the patients in his 2018 study had reported at least one adverse post-surgical event. When deposed, Cornell said that he’d talked to Elist about marketing strategies, not proprietary specifics, and that his invention had been spurred by potential hazards he’d observed during the surgeries, particularly the use of mesh. (Cornell and Wang did not comment for this story, though Wang denied through his counsel that he’d called Cornell a snake and said in court filings that he’d been named CEO without his consent.) The previous year, Cornell had asked to learn about the Penuma “expeditiously,” saying that he saw a “real opportunity to expand the level of service” he offered to patients. 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